The story of living in spite of melanoma, metastasis, vaccines, anti-PD-1, lung removal, and stereotactic radiation. The story of life with family and friends. {Posts under ~ Sew Chaotically, Travel Chaotically, and Chaotic Cookery also housed within! A girl's gotta have fun!}

About Me

Who am I? That is a question the rest of you could probably answer better than I. I am a wife, mother, daughter, sister, friend, pediatric nurse practitioner, cook, teacher, gardener, lover of words and music, occasional seamstress, and homemaker. I do have a couple of talents of questionable merit: I can create a decent meal in less than 30 minutes. I can feed and/or soothe almost any baby. And I can remember practically any song I've ever heard. For the rest, I'd rather those who know me decide.

Some of these reports focus on the improved outcomes of the combo vs the components alone. But it is also clear in some of these that folks do better when radiation is given prior to or WITH immunotherapy - rather than when radiation is given AFTER. Now there's this:

The
effect of timing of stereotactic radiosurgery treatment of melanoma
brain metastases treated with ipilimumab.
Cohen-Inbar, Shih, Xu, et al. J Neurosurg. 2017 Jan 6.Melanoma
represents the third most common cause of CNS metastases.
Immunotherapy has evolved as a treatment option for patients with
Stage IV melanoma. Stereotactic radiosurgery (SRS) also elicits an
immune response within the brain and may interact with immunotherapy.
The authors report on a cohort of patients treated for brain
metastases with immunotherapy and evaluate the effect of SRS timing
on the intracranial response. All consecutively treated melanoma
patients receiving ipilimumab and SRS for treatment of brain
metastases at the University of Virginia between 2009 and 2014 were
included in this retrospective analysis; data from 46 patients
harboring 232 brain metastases were reviewed. The median duration of
clinical follow-up was 7.9 months (range 3-42.6 months). The median
age of the patients was 63 years (range 24.3-83.6 years). Thirty-two
patients received SRS before or during ipilimumab cycles (Group A),
whereas 14 patients received SRS after ipilimumab treatment (Group
B). Radiographic and clinical responses were assessed at
approximately 3-month intervals after SRS. The 2 cohorts were
comparable in pertinent baseline characteristics with the exception
of SRS timing relative to ipilimumab. Local recurrence-free duration
(LRFD) was significantly longer in Group A (median 19.6 months, range
1.1-34.7 months) than in Group B patients (median 3 months, range
0.4-20.4 months). Post-SRS perilesional edema was more
significant in Group A. The effect of SRS and ipilimumab on LRFD
seems greater when SRS is performed before or during ipilimumab
treatments. The timing of immunotherapy and SRS may affect LRFD and
postradiosurgical edema. The interactions between immunotherapy and
SRS warrant further investigation so as to optimize the therapeutic
benefits and mitigate the risks associated with multimodality,
targeted therapy.Folks clearly did better when SRS was given before or during treatment with ipi, though there was an increased incidence of perilesional swelling for those patients. However a median recurrence-free duration of: 19.6 months vs 3 months!!!! Hhmmmmmm....On the topic of brain mets, here is a link to a nice review of treatment (Thanks, Eric!): Online library.wiley.com - Melanoma central nervous system metastases: current approaches, challenges, and opportunitiesWishing you all my best. - c

1 comment:

I received radiation for five consecutive days at the start of my treatment with ipi (I was part of a research study). I "flunked" ipi (developed severe colitis after 2nd of four infusions) but lungs are still NED and have been since April 2015! So, so glad I had the radiation.